• Susan G Hopkinson and Debra L Wiegand.
• School of Nursing, University of Maryland, Baltimore, Baltimore, MD, USA.
• J Clin Nurs. 2017 Dec 1; 26 (23-24): 5093-5102.

Aims And ObjectivesTo understand the occurrence of interruptions within the culture of the medical nursing unit work environment.BackgroundInterruptions may lead to errors in nursing work. Little is known about how the culture of the nursing work environment contributes to interruptions.DesignA micro-focused ethnographic study was conducted.MethodData collection involved extensive observation of a nursing unit, 1:1 observations of nurses and follow-up interviews with the nurses. Data were analysed from unstructured field notes and interview transcripts. The definitions of interruption and culture guided coding, categorising and identification of themes.ResultsA framework was developed that describes the medical nursing unit as a complex culture full of unpredictable, nonlinear changes that affect the entire interconnected system, often in the form of an interruption. The cultural elements contributing to interruptions included (i) the value placed on excellence in patient care and meeting personal needs, (ii) the beliefs that the nurses had to do everything by themselves and that every phone call was important, (iii) the patterns of changing patients, patient transport and coordination of resources and (iv) the normative practices of communicating and adapting.ConclusionsInterruptions are an integral part of the culture of a medical nursing unit. Uniformly decreasing interruptions may disrupt current practices, such as communication to coordinate care, that are central to nursing work. In future research, the nursing work environment must be looked at through the lens of a complex system.Relevance To Clinical PracticeInterventions to minimise the negative impact of interruptions must take into account the culture of the nursing as a complex adaptive system. Nurses should be educated on their own contribution to interruptions and issues addressed at a system level, rather than isolating the interruption as the central issue.© 2017 John Wiley & Sons Ltd.

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